Criteria to Choose between Distal or Proximal Venous Port Device Insertion in HNC Patients

Excerpt

We would like to make some comments about the article by Akahane et al. [1]. The authors compared two radiological venous port catheter procedures: proximal (chest) versus distal (arm) port insertion in head and neck cancer (HNC) patients. Real-time ultrasound guidance was used in the percutaneous (proximal) subclavian vein technique. Direct puncture was performed via the distal technique, apparently accessing the antebrachial veins, except in one case where venography was used. Fluoroscopy was performed in all cases to prevent initial catheter malposition. This retrospective comparative study showed significantly higher postprocedural complications (phlebitis and overall device complications) in the distal procedure patient group compared to the proximal one. In this study, the distal ports were placed in the forearm, a site associated with worse postoperative quality of life than when port insertion is performed in the arm [2]. Also, catheter length and the catheter–target vein diameter ratio are higher when the device is inserted in the forearm than in the arm or chest. …